1376658047 NPI number — MONARCH MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376658047 NPI number — MONARCH MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONARCH MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHUMAN MEDICAL CORPORATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376658047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40700 CALIFORNIA OAKS RD
Provider Second Line Business Mailing Address:
207
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-5789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-698-8554
Provider Business Mailing Address Fax Number:
951-698-8556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40700 CALIFORNIA OAKS RD
Provider Second Line Business Practice Location Address:
207
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-5789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-698-8554
Provider Business Practice Location Address Fax Number:
951-698-8556
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHUMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
951-698-8554

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  G47796 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1164400834 . This is a "NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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